Evaluation of pretransplant factors predicting cardiac dysfunction following high-dose melphalan conditioning and autologous peripheral blood stem cell transplantation
Article first published online: 13 JUL 2012
© 2012 John Wiley & Sons A/S
European Journal of Haematology
Volume 89, Issue 3, pages 228–235, September 2012
How to Cite
Bleeker, J. S., Gertz, M. A., Pellikka, P. A., Larson, D. R., Buadi, F., Dingli, D., Dispenzieri, A., Hayman, S. R., Hogan, W., Kumar, S., Rajkumar, S. V. and Lacy, M. Q. (2012), Evaluation of pretransplant factors predicting cardiac dysfunction following high-dose melphalan conditioning and autologous peripheral blood stem cell transplantation. European Journal of Haematology, 89: 228–235. doi: 10.1111/j.1600-0609.2012.01815.x
- Issue published online: 10 AUG 2012
- Article first published online: 13 JUL 2012
- Accepted manuscript online: 1 JUN 2012 12:55PM EST
- Manuscript Accepted: 28 MAY 2012
- Celgene and Travel
- Celgene, Millenium, Neotope Eisai, Inc.
- Celegene, Genzyme, Millenium, Novartis, Bayer, Merck, Cephalon, and Advisory Board
- Physician's Education Resource, and Amgen, Inc
- Lilly Research Laboratories
- Optum Health Education
- Research to Practice
- multiple myeloma;
- high-dose melphalan;
- stem cell transplant
Cardiac complications following hematopoietic stem cell transplantation (HSCT) are emerging as a significant concern given the increasing utilization of HSCT for a variety of hematologic malignancies.
We utilized an existing database to determine the frequency of cardiac dysfunction (CD), namely a decrease in left ventricular ejection fraction, following conditioning with high-dose melphalan (HDM) and autologous HSCT for multiple myeloma (MM) and systemic amyloidosis (AL). We then performed a case–control study to examine variables associated with increased risk of CD in this population.
In MM patients undergoing HSCT, the rate of CD was 1.6% (17/1050, 95% CI: [0.9, 2.6]). None of the examined pre-HSCT variables or HDM dose were significantly associated with development of CD in this population. In patients with AL, the rate of CD was 5.6% (24/426, 95% CI: [3.6, 8.3]). On univariate analysis, decision to administer an HDM dose <200 mg/m2 [odds ratio (OR): 4.59 (1.27–16.57) P = 0.02], pretransplant left ventricular ejection fraction <60% [OR: 17.78 (2.29–138.33) P = 0.006], and documented amyloid involvement of ≥3 organs [OR: 4.0 (1.03–15.6) P = 0.046] were associated with the development of CD in the AL population. No other examined peri-transplant factors were associated with development of CD.
To our knowledge, this is the first series to report a significant rate of CD following HDM conditioning and autologous HSCT in patients with AL.